Pulmonary metastases from prostate cancer

Abstract

Background. Lung metastases are rarely a significant factor in the management of prostate cancer. The usual pattern of spread is via lymphatic pathways, with pulmonary metastases virtually always occurring with osseous metastases. Previous reports suggest that androgen deprivation often fails to produce significant improvement in patients with pulmonary metastases; however, in the authors' experience, it has been successful in achieving objective responses. Methods. A retrospective review of a large prostate cancer data base was performed to identify patients with adenocarcinoma of the prostate and radiographic evidence of pulmonary metastases. A unique case of isolated pulmonary metastases with exsanguinating hemoptysis is described to illustrate the dramatic response to androgen deprivation. Results. Of 1290 patients with biopsy‐proven adenocarcinoma of the prostate, in 47 (3.6%) patients radiologic evidence of pulmonary metastases was observed. Twenty‐six (2.0%) patients demonstrated pulmonary metastases at the time of initial detection of metastatic disease. The radiographic appearance of pulmonary metastases was consistent with lymphangitic spread in the majority of patients. Of patients who received no hormonal therapy before the development of pulmonary metastases, 76.5% showed improvement in the appearance of their pulmonary lesions with androgen deprivation. As expected, survival was longer for those patients presenting with hormone‐naive disease and pulmonary metastases than for patients with hormone‐refractory disease and pulmonary metastases. The difference in survival, however, was not statistically significant. Conclusions. Pulmonary metastases are not encountered commonly in patients with prostate cancer. Androgen deprivation remains the most effective treatment and, among hormone‐naive patients, objective response is common. The prognosis for patients with hormone‐naïve disease and pulmonary metastases is not necessarily worse than for patients with metastatic disease at other sites. Cancer 1995;75:2706–9.

Prostate Cancer Metastasis Presenting as a Solitary Mass in the Lung: Case Report

“…3,7 A diffuse interstitial pattern, representing lymphatic spread, is the most common, however a multinodular pattern representing hematogenous spread may be seen on 8 to 20% of positive radiographs of patients with both prostate cancer and lung metastasis. 7,8 Solitary pulmonary nodules have been reported but are extremely rare. [4][5][6] Three unusual cases of isolated pulmonary recurrence of prostate cancer after initial definitive local therapy recently have presented.…”

Coincident detection of lung metastasis of prostate cancer and primary lung cancer: A case report

“…3 In a clinical study of 1290 patients diagnosed with prostate cancer, 48 patients had lung metastases, with only 11 patients (0.86%) having solitary nodule. 4 There have been several reports of isolated multiple pulmonary metastases; 5 however, none have reported lung metastases of prostate cancer and primary lung cancer detected at the same time. Our case is the first to present these unique characteristics.…”

Clinical significance of pulmonary metastases in stage D2 prostate cancer patients

“…The reported incidence of clinically apparent pulmonary metastases is 5 -27% at initial diagnosis, 19,20 whereas autopsy rates show an incidence of between 23 and 74%. 16 -18 In our study, pulmonary metastases had already developed in 20 of 152 (13%) patients at initial diagnosis and in 38 of 60 (63%) at cancer-death, respectively.…”

“…19 On the other hand, Fabozzi et al showed that endocrine therapy improved the radiographic appearance of pulmonary metastatic lesions in 13 (76.5%) of 17 patients who received no therapy before the development of pulmonary metastases. 20 Thus, the clinical impact of pulmonary metastases in the management of PCa remains obscure.…”